Red cell hypoplasia, cold hemoglobinuria and M-type gamma G serum paraprotein and Bence Jones proteinuria in a patient with lymphoproliferative disorder.

T HIS REPORT illustrates a dynamic or progressive relationship between a lymphoproliferative disorder associated with hypogammaglobulinemia, and myelomatosis indicated by serum protein analysis. A middle-aged man was hospitalized for hemoglobinuria and anemia requiring multiple transfusions. Later, hypogammaglobulinemia was observed. In blood, erythrocytes were normochromic, leukocyte and platelet counts were normal or increased, and small numbers (0-fl per cent) of atypical lymphocytes were present. Marrow aspirations yielded hypocellular material, but a surgically removed specimen of marrow contained large collections of lymphocytes suggestive of lymphocytic lymphoma. Approximately one year after hypogammaglobulinemia was first noted, monoclonal gammopathy (M protein) and Bence Jones proteinuria (Kappa) were documented. Three years after the first admission the patient died of infection. At autopsy, the lymph nodes and spleen were the sites of small numbers of myeloma-like cells having lymphocytic nuclei, and the bone marrow contained numerous plasmacytoid lymphocytes of the type associated with macroglobulinemia.